For doctors

Revolade belongs to a group of medicines called thrombopoietin receptor agonists. It is used to help increase the number of platelets in your blood. Platelets are blood cells that help to reduce or prevent bleeding.

Revolade is used to treat a bleeding disorder called immune ( idiopathic) thrombocytopenic purpura (ITP) in adult patients (aged 18 years and over) who have had their spleen removed and have received prior treatment with corticosteroids or immunoglobulins, and these medicines did not work. ITP is caused by a low blood platelet count ( thrombocytopenia). People with ITP have an increased risk of bleeding, and may notice symptoms such as petechiae (pinpoint sized flat round red spots under the skin), bruising, nosebleeds, bleeding gums and not being able to control bleeding if they are cut or injured.

Revolade may also be used in previously treated adult patients (aged 18 years and over) with chronic ITP where surgery to remove the spleen is not an option.

if you are allergic ( hypersensitive) to eltrombopag or any of the other ingredients of Revolade (listed in section 6 under ‘What Revolade contains’). Check with your doctor if you think this applies to you.

Take special care with Revolade

Your doctor needs to know before you take Revolade:

if you have liver problems. You should not be given Revolade unless your doctor considers that the expected benefits outweigh the risk of blood clots

if you are at risk of blood clots in your veins or arteries, or you know that blood clots are common in your family. The risk of blood clots may be increased in the following

circumstances: if you are elderly, if you have been bedridden for a long time, if you have cancer ( malignancy), if you are taking the contraceptive birth control pill or hormone replacement therapy, if you have undergone recent surgery or received a physical injury ( trauma), if you are overweight ( obese), if you are a smoker.

If any of these circumstances apply to you please tell your doctor before starting treatment.

if you have cataracts (the lens of the eye getting cloudy) Tell your doctor if any of these apply to you.

Checking for cataractsYour doctor may recommend that you are checked for cataracts as part of routine eye tests.

You will need regular blood tests Before you start taking Revolade your doctor will carry out blood tests to check your blood cells including platelets. These tests will be repeated at intervals while you are taking it.

Revolade can increase some blood markers indicating liver damage. You will have blood tests to check your liver function before you start taking Revolade and at intervals while you are taking it. You may need to stop taking Revolade if the amount of these substances increases too much, or if you get physical signs of liver damage.

Tell your doctor i mmediately if you have any of these signs and symptoms of liver problems:

yellowing of the skin or the whites of the eyes (jaundice)

- unusually dark-coloured urine.

If you stop taking Revolade a low blood platelet count ( thrombocytopenia) is likely to reoccur within several days. If you stop taking Revolade your platelet count will have to be monitored, and your doctor will discuss appropriate precautions with you.

If you have very high blood platelet counts, this may increase the risk of blood clotting, however blood clots can occur with normal or even low platelet counts. Your doctor will adjust your dose of Revolade to ensure that your platelet count does not become too high.

Tell your doctor i mmediately if you have any of these signs and symptoms of a blood clot:

Taking other medicinesTell your doctor or pharmacist if you are taking any other medicines, have taken any recently, or if you start new ones. This includes herbal medicines and other medicines you can obtain without a prescription.

Some everyday medicines interact with Revolade – including prescription and non-prescription medicines and minerals. These include:

antacid medicines to treat indigestion, heartburn or stomach ulcers

medicines called statins, used to lower cholesterol

minerals such as iron, calcium, magnesium, aluminium, selenium and zinc which may be found in vitamin and mineral supplements

medicines such as methotrexate and topotecan, used to treat cancer

See Section 3, ‘How to take Revolade’, for more information about taking antacids, vitamins and mineral supplements

Talk to your doctor if you take any of these. Some of them are not to be taken with Revolade,, or your dose may need adjusting, or you may need to alter the timing of when you take them. Your doctor will review the medicines you are taking, and suggest suitable replacements if necessary.

If you are also taking medicines which are given to prevent blood clots ( anticoagulants or antiplatelet therapy) there is a greater risk of bleeding. Your doctor will discuss this with you.

If you are taking corticosteroids, danazol, and/or azathioprine these may be reduced or

stopped when given together with Revolade.

Revolade with food and drink

Revolade is not to be taken with dairy foods or drinks as the absorption of the medicine is affected by the calcium in dairy products. For details, see Section 3, How to take Revolade.

Pregnancy and breast-feeding

Don’t use Revolade if you are pregnant unless your doctor specifically recommends it. The effect of Revolade during pregnancy is not known.

Tell your doctor if you are pregnant or planning to become pregnant.

Use a reliable method of contraception while you’re taking Revolade, to prevent pregnancy

If you do become pregnant during treatment with Revolade, tell your doctor.

Don’t breast-feed while you are taking Revolade. It is not known whether Revolade passes into breast-milk.

If you are breast-feeding or planning to breast-feed, tell your doctor.

Driving and using machines

No studies on the effects of Revolade on the ability to drive or use machines have been performed.

Always take Revolade exactly as your doctor has told you. Check with your doctor or pharmacist if you are not sure.

How much to take

The usual starting dose is one 50 mg tablet of Revolade a day. People of East Asian origin (Chinese, Japanese, Taiwanese or Korean) may need to start at a lower dose of 25 mg.

Swallow the tablet whole, with some water.

Revolade may take 1 to 2 weeks to work. Based on your response to Revolade your doctor may recommend that your daily dose is changed.

Revolade is not recommended for people aged under 18, as the safety and effectiveness have not yet been shown.

When to take it

Don’t take Revolade in the 4 hours before or after:

dairy foods such as cheese, butter, yoghurt or ice cream

milk or milk shakes, drinks made with milk, yoghurt or cream

antacids, which are medicines for indigestion

some mineral and vitamin supplements including iron, calcium, magnesium, aluminium, selenium and zinc If you do, the medicine will not be properly absorbed into your body.

For more advice about suitable foods, talk to your doctor.

If you take more Revolade than you should

Contact a doctor or pharmacist immediately. If possible show them the pack, or this leaflet. It is recommended that you are monitored for any signs or symptoms of side effects and that you are given appropriate treatment immediately.

If you forget to take Revolade

Take the next dose at the usual time. Don’t take a double dose to make up for a forgotten dose.

If you stop taking Revolade

Don’t stop taking Revolade without talking to your doctor. If your doctor advises you to stop treatment, your platelet count will then be checked each week for four weeks.

Like all medicines, Revolade can cause side effects, although not everybody gets them.

Bleeding after you stop treatment Within two weeks of stopping Revolade, your blood platelet count will usually drop back down to what it was before you started taking Revolade. The lower platelet count may increase your risk of bleeding. Your doctor will check your platelet counts for at least 4 weeks after you stop taking Revolade.

Tell your doctor if you have any bruising or bleeding after you stop taking Revolade.

Problems with your bone marrow People with ITP may have problems with their bone marrow. Medicines like Revolade could make this problem worse. Signs of bone marrow changes may show up as abnormal results in your blood tests. Your doctor may also carry out tests to directly check your bone marrow during treatment with Revolade.

High platelet counts Your doctor will check your blood platelet count during treatment. If your platelet count gets too high, your dose of Revolade may need to be changed, or you may need to stop taking it.

Higher risk of blood clots People with ITP may have a higher risk of blood clots, and medicines like Revolade could make this problem worse.

Revolade is used in adults with long-term immune thrombocytopenic purpura (ITP), a disease in which the patient’s immune system destroys the platelets (components in the blood that help it to clot). Patients with ITP have low platelet counts and are at risk of bleeding.

Revolade is used in patients who have had their spleen removed and who do not respond to treatment with medicines such as corticosteroids or immunoglobulins. It can also be considered for use in patients who have previously been treated for ITP who cannot have surgery to remove their spleen. The spleen is an organ that is involved in the destruction of platelets.

Because the number of patients with ITP is low, the disease is considered ‘rare’, and Revolade was designated an ‘orphan medicine’ (a medicine used in rare diseases) on 3 August 2007.

Treatment with Revolade should be supervised by a doctor who has experience in treating blood diseases.

The recommended starting dose is 50 mg once a day, except in patients of East Asian descent (such as Japanese, Chinese, Taiwanese or Korean) where it should be 25 mg once a day. After treatment has started, the dose should be adjusted for each patient with the aim of keeping the level of platelets high enough to prevent bleeding (above 50,000 platelets per microlitre). The daily dose should not exceed 75 mg. Patients should not take any antacids, dairy products or mineral supplements for four hours before or four hours after taking Revolade. For more information, see the summary of product characteristics (also part of the EPAR).

The active substance in Revolade, eltrombopag, stimulates the production of platelets. In the body, a hormone called ‘thrombopoietin’ stimulates the production of platelets by attaching to certain receptors in the bone marrow. Eltrombopag attaches to and stimulates the same receptors as thrombopoietin. This leads to an increased production of platelets.

Revolade was compared with placebo (a dummy treatment) in two main studies involving a total of 311 adults with chronic ITP. The patients had previously been treated but the treatments had not worked or the disease had come back. All of the patients had a platelet count of less than 30,000 per microlitre at the start of the studies. In the first study, the main measure of effectiveness was the number of patients whose platelet count had increased to at least 50,000 cells per microlitre after six weeks. In the second study, it was the number of patients who had a platelet count between 50,000 and 400,000 per microlitre during six months of treatment.

Revolade was more effective than placebo at treating patients with chronic ITP. In the first study, 59% of the patients who took Revolade (43 out of 73) had a platelet count of at least 50,000 per microlitre after six weeks, compared with 16% of those who took placebo (6 out of 37). In the second study, patients taking Revolade were around eight times more likely than those taking placebo to reach a platelet count of between 50,000 and 400,000 per microlitre during the six months of treatment.

The most common side effect with Revolade (seen in more than 1 patient in 10) is headache. There is also a risk of liver problems and thromboembolic complications (problems with clots in blood vessels). Bleeding can also come back after the medicine is stopped. For the full list of all side effects reported with Revolade, see the Package Leaflet.

Revolade should not be used in people who may be hypersensitive (allergic) to active substance or any of the other ingredients. The medicine should be used with caution in patients who have liver problems. For more information, see the summary of product characteristics.

The company that makes Revolade will ensure that doctors in all Member States who will prescribe the medicine are provided with educational materials reminding them how the medicine should be used and of the medicine’s possible side effects such as liver problems, thromboembolic complications and the recurrence of bleeding.

The European Commission granted a marketing authorisation valid throughout the European Union for Revolade to GlaxoSmithKline Trading Services Limited on 11 March 2010. The marketing authorisation is valid for five years, after which it can be renewed.

The summary of the opinion of the Committee for Orphan Medicinal Products for Revolade can be found on the Agency’s website: ema.europa.eu/Find medicine/Human medicines/Rare diseasedesignations. europa.eu/Find medicine/Human medicines/European Public Assessment Reports. For more information about treatment with Revolade, read the Package Leaflet (also part of the EPAR) or contact your doctor or pharmacist.